PROSTABLOG NZ: Exact meaning of the word “encourage” will be pivotal in the continuing New Zealand saga on how best to prevent prostate cancer.

“We will be encouraging men to go to their GPs to discuss options…including whether or not they should have a PSA test,” says the chairman of Parliament’s inquiry into prostate cancer, Paul Hutchison, in today’s Dominion Post newspaper (see below).

In the same story, his statement is welcomed by Prostate Cancer Foundation of NZ president Mark von Dadelszen: “…we would certainly applaud that move.”

What they both mean by the term “encourage” is about to become the focus of a debate that has churned around in global prostate cancer politics since PSA testing became commonly available in the early 1990s.

First question: how does “encouraging” men to be tested differ from a national screening programme (which Hutchison signals will be rejected in the inquiry report due in a matter of weeks)?

A national screening programme presumably involves the Ministry of Health spending millions promoting tests to the general populace, as it does with breast and cervical cancers.

Such programmes “encourage” people to get along to their doctor and have the tests.

How will men be encouraged? Not with a lot of advertising, it seems.

So how, exactly?

By training barbers to spread the word to their clients, as has been tried in the US?

By sending doctors into communities to talk about risks and options, as the Foundation did last year when it flew a team to the Chathams?

By leaving it to the Foundation to publicise the disease and urge men to act, as happens now?

Whatever approach the Health Select Committee is about to recommend, it needs to deal with a mammoth in the waiting rooms – the Ministry of Health instruction to GPs that they must not raise the topic of PSA and rectal examination until the patient does or unless they spot symptoms obviously related to what is often a symptomless disease.

This is the real crux of the dilemma the Select Committee has presumably been wrangling with since its first public hearings in September, 2009.

What instruction will it recommend the Government give to the Ministry, whose staff and advisers adamantly oppose any widening of the availability of PSA testing?

Up to now, men have been the subject of a mild but just as deadly form of Russian roulette when it comes to being diagnosed.

Take my own case.

Over the past 30 years, I’ve been under the care of four GPs. The first never mentioned prostate cancer (to be fair, I was under 50); the second (mid 1990s) refused to consider PSA tests because to him they were unproven; the third insisted on it without my bidding; and my current one responded readily to my request for tests (saying Ministry instructions forbade him raising the matter unless I spoke up first!).

The Foundation’s awareness campaigns have been effective, if I judge by the number of male acquaintances now being diagnosed early and successfully treated.

However, I suspect there are dangerous class factors at play here.

Me and my mates are okay because we have been blessed by education, higher socio-economic status, media awareness and access to health provision.

I fear for those who don’t. The Ministry’s stubbornness condemns them to an uncertain fate.

National prostate screening rejected

Dominion Post April 2, 2011

A PARLIAMENTARY inquiry into prostate cancer screening will not be recommending a national screening programme despite pressure from cancer survivors to do so.

The Prostate Cancer Foundation has backed the committee’s approach, but a former patient says the decision is disappointing.

Health select committee chairman Paul Hutchison said the inquiry, which has been running since May 2009, was not due to report back for another few weeks, but when it did, it would not advocate screening.

There was still controversy over whether blood tests for prostate-specific antigens led to fewer prostate cancer deaths, he said.

Heightened levels of prostate specific antigen – PSA – can indicate the presence of prostate cancer. However, early detection can result in aggressive and unpleasant treatment of tumours that would never have grown or created ill-health.

The inquiry has heard from a huge number of prostate cancer survivors, many of whom asked for a screening programme for all men aged 50 and older.

Dr Hutchison could not go into detail about the committee’s findings but said there were two main conclusions.

‘‘We will not be recommending a PSA screening programme. However, we will be encouraging men to go to their GPs to discuss options … including whether or not they should have a PSA test.

‘‘Those are the two points that are loud and clear.’’

Prostate Cancer Foundation president Mark von Dadelszen said the organisation did not support a national screening programme because of ‘‘issues’’ with the PSA test.

‘What it does advocate is that men should be encouraged to have screening tests . . . we would certainly applaud that move.’’

Napier farmer Duncan McLean, who has just got the all-clear five years after being diagnosed with prostate cancer, said encouragement was good but the committee should recommend a full screening programme.

Mr McLean, 57, had his prostate gland removed in 2006 after several years of increasingly high PSA readings, followed by a biopsy that confirmed the cancer.

Fears about over-treatment were ‘‘bollocks’’, he said. ‘‘You don’t leap in and go under the surgeon’s knife – I was monitored for three years before I had surgery.’’

International research on the matter is split, with several largescale studies under way.

The results of a 20-year Swedish study, published yesterday in the British Medical Journal, found screening did not significantly reduce prostate cancer deaths but the risk of overdetection and unnecessary treatment was considerable.

However, another Swedish study found death from prostate cancer more than halved among men who were screened.

NEW PROSTATE CANCER INFOLINK: It is time for us to take a step back and look at the whole issue of cancer screening with unblinkered eyes, writes Mike Scott of the American Cancer Society’s announcement it will review its policy on cancer screening. READ MORE>

The “New” Prostate Cancer InfoLink expects to receive a lot of “flak” about this particular commentary, but we are adamant about the need for a whole new attitude to cancer screening — an attitude that is based fundamentally on the very best interests of the patient with clinically significant cancer that needs to be found and on the very best interests of consumers in whom it may well be possible to identify cancer cells but who need to know that this form of cancer is of little clinical relevance to their lives.

NEW YORK TIMES: The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated. READ MORE>

JUNE 16: NEW PROSTATE CANCER INFO-LINK: The whole issue of the appropriateness of cancer screening is starting to become a major public health issue, closely and inevitably associated with cancer risk, writes Mike Scott. READ MORE>

“The New Prostate Cancer Infolink believes we can expect strong feelings to be expressed on both sides of this issue over the next few years, and we want to go on record now as stating that the currently available data for and against the appropriateness of screening for almost every form of cancer is generally very poor.

“We are never going to be able to resolve any of these issues until be get a lot better at at least some — and preferably all — of the following:

The early differential diagnosis of cancers by clinical risk — in other words, being able to have much better understanding at the time of diagnosis of who really needs aggressive treatment because their cancer may either shorten their life or severely affect its quality.

Explaining to individual patients why aggressive treatment may not be in their best interests if they have every indication of low risk, indolent forms of cancer.

Alignment of physicians’ financial reimbursement with truly appropriate medical practice — so that a urologist (for example) is as reasonably compensated for convincing a 70-year-old patient that expectant management is probably an excellent form of care for his prostate cancer, given his particular circumstances, as the urologist would be for carrying out a radical prostatectomy.

Teaching society that the vast majority of cancer diagnoses have long since ceased to be a death sentence (although there are still plenty of exceptions to that statement).”

MAY 13: BLOOMBERG: A third of men and a quarter of women undergoing cancer screening will get false positive results by the time they have undergone four tests, which can lead to inappropriate medical procedures, a study found. READ MORE> and analysis HERE>